Initial Oxygen Concentration for the Resuscitation of Infants Born at Less Than 32 Weeks' Gestation: A Systematic Review and Individual Participant Data Network Meta-Analysis.

IF 24.7 1区医学 Q1 PEDIATRICS

JAMA Pediatrics Pub Date : 2024-08-01 DOI:10.1001/jamapediatrics.2024.1848

James X Sotiropoulos, Ju Lee Oei, Georg M Schmölzer, Sol Libesman, Kylie E Hunter, Jonathan G Williams, Angela C Webster, Maximo Vento, Vishal Kapadia, Yacov Rabi, Janneke Dekker, Marijn J Vermeulen, Venkataseshan Sundaram, Praveen Kumar, Risma K Kaban, Rinawati Rohsiswatmo, Ola D Saugstad, Anna Lene Seidler

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引用次数: 0

Abstract

Importance: Resuscitation with lower fractional inspired oxygen (FiO2) reduces mortality in term and near-term infants but the impact of this practice on very preterm infants is unclear.

Objective: To evaluate the relative effectiveness of initial FiO2 on reducing mortality, severe morbidities, and oxygen saturations (SpO2) in preterm infants born at less than 32 weeks' gestation using network meta-analysis (NMA) of individual participant data (IPD).

Data sources: MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and WHO ICTRP from 1980 to October 10, 2023.

Study selection: Eligible studies were randomized clinical trials enrolling infants born at less than 32 weeks' gestation comparing at least 2 initial oxygen concentrations for delivery room resuscitation, defined as either low (≤0.3), intermediate (0.5-0.65), or high (≥0.90) FiO2.

Data extraction and synthesis: Investigators from eligible studies were invited to provide IPD. Data were processed and checked for quality and integrity. One-stage contrast-based bayesian IPD-NMA was performed with noninformative priors and random effects and adjusted for key covariates.

Main outcomes and measures: The primary outcome was all-cause mortality at hospital discharge. Secondary outcomes were morbidities of prematurity and SpO2 at 5 minutes.

Results: IPD were provided for 1055 infants from 12 of the 13 eligible studies (2005-2019). Resuscitation with high (≥0.90) initial FiO2 was associated with significantly reduced mortality compared to low (≤0.3) (odds ratio [OR], 0.45; 95% credible interval [CrI], 0.23-0.86; low certainty) and intermediate (0.5-0.65) FiO2 (OR, 0.34; 95% CrI, 0.11-0.99; very low certainty). High initial FiO2 had a 97% probability of ranking first to reduce mortality. The effects on other morbidities were inconclusive.

Conclusions and relevance: High initial FiO2 (≥0.90) may be associated with reduced mortality in preterm infants born at less than 32 weeks' gestation compared to low initial FiO2 (low certainty). High initial FiO2 is possibly associated with reduced mortality compared to intermediate initial FiO2 (very low certainty) but more evidence is required.

查看原文本刊更多论文

对妊娠不足 32 周的新生儿进行复苏时的初始氧气浓度：系统回顾与个体参与者数据网络元分析》。

重要性：使用较低的充氧分数（FiO2）进行复苏可降低足月儿和近足月儿的死亡率，但这种做法对极早产儿的影响尚不清楚：目的：通过对个体参与者数据（IPD）进行网络荟萃分析（NMA），评估初始 FiO2 在降低妊娠不足 32 周早产儿死亡率、严重发病率和血氧饱和度（SpO2）方面的相对效果：数据来源：MEDLINE、Embase、CENTRAL、CINAHL、ClinicalTrials.gov 和 WHO ICTRP，时间从 1980 年至 2023 年 10 月 10 日：符合条件的研究均为随机临床试验，纳入了妊娠不足 32 周出生的婴儿，比较了至少两种产房复苏初始氧气浓度，即低浓度（≤0.3）、中浓度（0.5-0.65）或高浓度（≥0.90）FiO2：邀请符合条件的研究者提供 IPD。对数据进行处理并检查其质量和完整性。采用非信息先验和随机效应进行了基于对比的单阶段贝叶斯 IPD-NMA，并对关键协变量进行了调整：主要结果和测量指标：主要结果是出院时的全因死亡率。次要结果为早产儿的发病率和 5 分钟时的 SpO2：在 13 项符合条件的研究（2005-2019 年）中，有 12 项研究为 1055 名婴儿提供了 IPD。与低（≤0.3）（几率比 [OR]，0.45；95% 可信区间 [CrI]，0.23-0.86；低确定性）和中等（0.5-0.65）FiO2（OR，0.34；95% CrI，0.11-0.99；极低确定性）相比，高（≥0.90）初始 FiO2 复苏与死亡率显著降低相关。在降低死亡率方面，高初始 FiO2 的概率为 97%。对其他疾病的影响尚无定论：与低初始 FiO2（低确定性）相比，高初始 FiO2（≥0.90）可能与降低妊娠不足 32 周早产儿的死亡率有关。与中等初始 FiO2 相比，高初始 FiO2 可能与降低死亡率有关（确定性很低），但还需要更多证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JAMA Pediatrics PEDIATRICS-

CiteScore

31.60

自引率

1.90%

发文量

357

期刊介绍： JAMA Pediatrics, the oldest continuously published pediatric journal in the US since 1911, is an international peer-reviewed publication and a part of the JAMA Network. Published weekly online and in 12 issues annually, it garners over 8.4 million article views and downloads yearly. All research articles become freely accessible online after 12 months without any author fees, and through the WHO's HINARI program, the online version is accessible to institutions in developing countries. With a focus on advancing the health of infants, children, and adolescents, JAMA Pediatrics serves as a platform for discussing crucial issues and policies in child and adolescent health care. Leveraging the latest technology, it ensures timely access to information for its readers worldwide.

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